Psychopathology: concepts and clinical applications

Psychology - Treatment Approaches

MAJOR APPROACHES in TREATING PERSONALITY DISORDERS

Explore the major approaches for the treatment of personality disorders.

Treatment of personality disorders includes a wide spectrum of therapeutic modalities with different applicability depending on the specific nature of the type of personality disorder at issue. Generally, patients suffering from personality disorders benefit from some form of psychotherapy, behavioral therapy, or drug therapy; sometimes, different therapy modalities are used in combination. Ordinarily, personality disorders do not require in-patient hospitalization, except for patients suffering from delusions associated with acute paranoia, patients whose symptoms include suicidal tendencies and patients suffering symptoms of acute drug or alcohol withdrawal (Coleman, Butcher and Carson 1994).

Freudian psychoanalysis and psychodynamic psychotherapy emphasize insight- oriented analysis of conflicts whose origin lie within the patient's subconscious, and more specifically, conflicts that are directly attributable to various elements of the parent- child relationship as well as to the separation issues and repressed sexual desires detailed by Sigmund Freud in the early 20th century. Both strict Freudian psychoanalysis and psychodynamic psychotherapy incorporate the analysis of dreams, although the latter approach usually involves more input from the therapist than the former (Gerrig and Zimbardo 2005).

The cognitive-behavioral approach to treatment de-emphasizes the role of understanding the subconscious origin of psychological disorders and focuses more directly on the associations and "triggers" of psychological symptoms and on reversing the conditioning that accounts for personality disorders. Consequently, this type of therapy is more conducive to the treatment of symptoms that relate to learned responses and to anxieties and unreasonable fears or phobias triggered by specific situations capable of being reduced through systematic desensitization (Coleman, Butcher and Carson 1994).

Most personality disorders can be broadly grouped into (1) paranoid or schizophrenic disease, (2) narcissistic, histrionic, borderline, and antisocial disorders, and (3) obsessive-compulsive, dependant, or avoidant disorders with specific forms of therapy dictated more by the particular symptoms and their severity (Shapiro 1999).

Paranoid/Schizoid personality disorders are difficult to treat via insight-oriented therapeutic approaches, mainly because the patient is prone to doubt the motives of the therapist by virtue of the nature of the symptoms of the disease itself: namely, paranoid delusions that convince the patient that the therapist is part of a larger "conspiracy" against the patient (Shapiro 1999).

Narcissistic, histrionic, borderline, and antisocial disorders are treatable via several insight-oriented, one-on-one psychoanalytic psychotherapeutic approaches conducted by specialists in those types of disorders, as are many obsessive-compulsive and avoidant disorders (Gerrig and Zimbardo 2005). Alternatively, obsessive- compulsive, dependant, and especially, avoidant disorders are treatable in group settings as well. Avoidant and dependent personality disorders, in particular, may be best-suited to cognitive behavioral therapeutic approaches where the roots of the patient's disorder relates to distorted self-perceptions capable of being addressed directly (Coleman, Butcher and Carson 1994).

Where paranoid or schizophrenic personality disorders are associated with acute psychotic episodes and intense delusions, antipsychotic drugs are used to reduce symptoms sufficiently for the patient to benefit from supportive therapy. This is less likely to trigger the defensive reaction to the therapist often associated with attempts to treat acute paranoia or schizoid symptoms through insight-oriented psychotherapy (Shapiro 1999).